Provider Demographics
NPI:1750747135
Name:PECK, CORNELL TERRI (RN, BSN)
Entity type:Individual
Prefix:
First Name:CORNELL
Middle Name:TERRI
Last Name:PECK
Suffix:
Gender:M
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1955 POPPS FERRY RD
Mailing Address - Street 2:APT. M-2067
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-2029
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1955 POPPS FERRY RD
Practice Address - Street 2:APT. M-2067
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-2029
Practice Address - Country:US
Practice Address - Phone:228-257-8175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS899807163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine